女性肠易激综合征患者核磁共振脑功能成像研究初探

沈晓伶　宋毓飞　张谢

[摘要] 目的 通过核磁共振脑功能成像观察女性肠易激综合征患者（irritable bowel syndrome，IBS）及正常人在直肠刺激时脑内活动区表现的差异，探究肠易激综合征的发病机制。 方法 根据综合性医院焦虑抑郁量表对2013年6月～2014年9月间20例女性IBS患者进行精神心理评估并分组，同时将入选的20例女性IBS患者和9例健康对照组分别应用血氧水平依赖性功能性磁共振成像技术，给予直肠气囊扩张刺激试验，记录脑内激活情况。 结果 在直肠刺激为40 mL时，正常组激活的脑数点为4个，IBS焦虑组为2个，IBS非焦虑组为10个；在直肠刺激为80 mL时，正常组激活的脑数点为3个，IBS焦虑组为22个，IBS非焦虑组无有效激活；在直肠刺激为120 mL时，正常组无有效激活，IBS焦虑组为2个，IBS非焦虑组为2个。故IBS组及正常组脑内激活情况与给予的刺激强度并不成正比，但焦虑IBS组在给予80 mL、120 mL刺激时脑内激活情况明显强于对照组及非焦虑组。 结论 核磁共振脑功能成像可以客观记录IBS患者在接受刺激时脑内的激活变化情况，其结果与心理测试基本同步，焦虑/抑郁的IBS患者可能在接受心理治疗后可获得更大的收益。

[关键词] 肠易激综合征；核磁共振脑功能成像技术；焦虑抑郁量表

[中图分类号] R574；R445.2 [文献标识码] B [文章编号] 1673-9701（2016）16-0096-05

[Abstract] Objective To study the brain activity zone of the woman with irritable bowel syndrome（IBS） and normal controls by functional magnetic resonance imaging and explore the pathogenesis of irritable bowel syndrome. Methods 20 female IBS patients from Jun 2013 and Sep 2014 were recruited for this study. The IBS patients were accepted psychological assessments and classify according to the Hospital Anxiety and Depression Scale （HADS）. While enrolled 20 female IBS patients and 9 healthy controls were applied blood oxygen level-dependent functional magnetic resonance imaging（f-MRI）， giving rectal balloon distention test， recorded brain activation. Results When rectal irritation as 40 mL，normal activation of brain several points to 4， IBS anxiety group point 2， IBS non-anxiety group point 10； when rectal irritation as 80 mL， normal activation of brain several points 3， IBS anxiety group point 22， IBS non-anxiety group without a valid activation； when the rectal irritation to 120 mL， normal group without a valid activation， IBS anxiety group point 2， IBS without anxiety group point 2. Therefore IBS group and normal brain activation and stimulation intensity given not proportional， but anxiety IBS group given 80 mL， 120 mL stimulus when the brain activation was significantly stronger than in the control group and non-anxiety group. Conclusion The brain activation changes of the IBS patients could be recorded objectively by the fMRI and consistent with the psychological tests. IBS patients with anxiety or depression may obtain greater benefit when they received psychological treatment.

[Key words] Irritable bowel syndrome； Functional magnetic resonance imaging； Hospital anxiety and depression scale

肠易激综合征（irritable bowel syndrome，IBS）是一种常见的功能性胃肠病，病程长，临床上尤以女性多见。以往认为多数IBS患者存在精神、心理异常，精神因素影响病程，但往往缺乏有效的客观评价指标。本研究旨在通过应用临床心理评估……